Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications

Figures & data

Table 1 Demographic Characteristics of Selected Patients

Characteristics	Frequency (N)	Percentage (%)
Gender
Male	159	62.1
Female	97	37.9
Age group
Less than 18 years	28	11.0
19–40 years	32	12.7
41–60 years	39	15.4
61–85 years	161	63.1
Sample
Pus	171	66.8
Urine	54	21.1
Tissue	17	6.6
Dead Bone	6	2.3
Blood	4	1.6
Tracheal secretion	3	1.2
CSF	1	0.4
Isolated microbes
MSSA	138	53.9
E.coli	118	46.1
Past surgical history
Yes	152	59.4
No	104	40.6
Ward
Orthopedic	256	100
CRP
No	216	84.4
Yes	40	15.7
ESR
Yes	39	15.2
No	217	84.8
OTHER COMPLICATIONS
Diabetes	57	22.2
Hepatitis C	35	13.6
Hypertension	30	11.7
TB	8	3.1
IHD	6	2.3
Hepatitis B	4	1.5

Abbreviations: CSF, Cerebro Spinal Fluid; MSSA, Methicillin-sensitive Staphylococcus aureus; E. coli, Escherichia coli; NICU, Neonatal intensive care units, CRP, C-reactive protein; ESR, Erythrocyte Sedimentation rate, TB, tuberculosis, IHD, Ischemic Heart Disease.

Table 2 Antibiotic Sensitivity Pattern of E. coli and MSSA Isolates

Antibiotics	E.coli	MSSA
	Sensitivity n (%)	Sensitivity n (%)
Cephalosporin
Cefoxitin	NT	130/130(100)
Cefazolin	NT	(85.7)
Cefuroxime	5/88(5.7)	30/47(63.8)
Cefoperazone + Sulbactam	18/30(60)	NT
Ceftriaxone	8/100(8)	26/45(57.8)
Ceftazidime	9/29(31)	6/16(37.5)
Cefipime	11/52(21.2)	5/16(31.3)
Cefixime	2/58(3.5)	5/17(29.4)
Cefoperazone	1/23(4.4)	NT
Quinolones
Levofloxacin	28/82(34.2)	32/45(71.1)
Ciprofloxacin	17/74(23)	49/92(53.3)
Norfloxacin	10/44(22.7)	26/55(47.3)
Ofloxacin	6/29(20.7)	6/11(54.5)
Nalidixic	7/40(17.5)	NT
Penicillin
Oxacillin	NT	8/8(100)
Piperacillin + tazobactam	71/111(71)	10/17(58.8)
Co-Amoxiclav	12/86(14)	13/25(52)
Penicillin	NT	30/104(28.9)
Ampicillin	7/104(6.7)	12/46(26.1)
Carbapenems
Imipenem	81/101(80.2)	12/17(70.6)
Ertapenem	49/69(71)	NT
Meropenem	81/108(75)	18/24(75)
Macrolide
Clarithromycin	NT	16/19(84.2)
Erythromycin	NT	89/133(66.9)
Aminoglycoside
Amikacin	87/103(84.5)	101/112(90.2)
Gentamicin	51/96(53.1)	85/108(78.7)
Tobramycin	30/59(50.9)	39/59(66.1)
Oxalidone
Linezolid	NT	121/127(95.3)
Glycopeptide
Vancomycin	NT	122/122(100)
Teicoplanin	NT	46/66(69.7)
Lincomycin
Clindamycin	NT	96/125(76.8)
Phosphonic acid Antibiotics
Fosfomycin	48/48(100)	3/3(100)
Polymyxin
Colistin	58/60(96.7)	11/11(100)
Polymyxin B	58/61(95.1)	11/12(91.7)
Antimycobacterials
Rifampicin	NT	51/58(87.9)
Tetracycline
Tigecycline	52/56(92.9)	54/58(93.1)
Minocycline	20/44(45.5)	33/38(86.8)
Tetracycline	17/80(21.3)	43/80(53.7)
Sulfonamide
Nitrofurantoin	13/14(76.5)	NT
Co-Trimoxazole	12/81(14.8)	21/83(25.3)
Others
Chloramphenicol	33/41(80.5)	71/77(92.2)

Abbreviation: NT, Not Tested.

Table 3 De-Escalation of Antibiotics

Antibiotics	E.coli			MSSA			Total
	Before	After	% Change	Before	After	% Change	Before	After	% Change
Inj. Cefoperazone+Sulbactam^a	53	25	↓53	98	16	↓84	151	41	↓73
Inj. Amikacin^a	54	34	↓37	95	15	↓84	149	49	↓67
Inj. Ceftriaxone^a	19	7	↓63	14	8	↓43	33	15	↓55
Inj. Metronidazole^b	21	6	↓71	9	4	↓56	30	10	↑67
Inj. Piperacillin+Tazobactam^c	22	19	↓14	0	0	0	22	19	↓14
Inj. Meropenem^c	12	34	↑183	8	3	↓63	20	37	↑85
Inj. Vancomycin^d	7	0	↓100	9	7	↓22	16	7	↓56
Inj. Ciprofloxacin^a	9	8	↓11	5	3	↓40	14	11	↓21
Tab. Co-amoxiclav^a	2	2	0	11	5	↓55	13	7	↓46
Inj. Moxifloxacin^a	8	2	↓75	5	1	↓80	13	3	↓77
Tab.Ciprofloxacin^a	3	21	↑600	8	11	↑38	11	32	↑191
Inj. Cefotaxime^a	10	1	↓90	0	0	0	10	1	↓90
Inj. Linezolid^d	2	0	↓100	5	9	↑80	7	9	↑29
Inj. Co-amoxiclav^a	4	1	↓75	2	3	↑50	6	4	↓33
Inj. Ampicillin^a	4	0	↓100	2	0	↓100	6	0	↓100
Tab. Linezolid^d	2	0	↓100	4	39	↑875	6	39	↑550
Inj. Clindamycin^a	2	0	↓100	4	6	↑50	6	6	0
Inj. Imipenem + Cilastatin^c	3	5	↑67	2	2	0	5	7	↑40
Inj. Levofloxacin^a	2	9	↑350	1	6	↑500	3	15	↑400
Tab. Clindamycin^a	0	0	0	3	24	↑700	3	24	↓700
Fosfomycin Sachet^a	1	11	↑1000	1	1	0	2	12	↑500
Total	240	185	↓23	286	163	↓43	526	348	↓34%

Notes: ^aBroad Spectrum, ^bNarrow Spectrum, ^cExtended Spectrum, ^dBroad Spectrum only for Gram Positive microbes, otherwise Narrow Spectrum, ↓; Reduce, ↑; Increase, Bold; Reduce, Italic; Increase.